Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

28 comments:

the second view shows the radiology tech's hand holding the patient's toes to allow the film to be taken. if you look where the ankle should be you will see dark areas inside light areas... two areas are kinda on top of each other on this film. this is air, and, erdoc85 will correct me if i'm wrong, but from the film it looks as if the blast almost amputated the ankle and that it was pretty floppy- hence the need for someone's hand in the film.

the white dots are shotgun pellets, and, if i'm not mistaken, this film was taken with the patient on a backboard.

the backboard was only necessary to transport the patient without his leg falling off. the backboard is the straight line on the second film behind the 'ankle'.

i bet there was not spurting blood contrary to what you might suppose. the high pressure vessels supplying the foot probably contracted immediately after the blast, and while the foot was a hamburger-y, bloody mess, he probably did not need a tourniquet or BP cuff to staunch the bleeding.

Not that it matters, but what size was the shot? (It did the damage) That's kinda neat that he had a dorsalis pedis but like you said-pretty much self cauterized the wound! I think I would have drunk some likker or just pored some on me to make it look like a better accident! Porcupine IQ- LOL

no worries! you are probably on the trauma side. sub-q emphsema is bad in chest/neck trauma but we also see it outside trauma with 'gas gangrene', there the air is from bacteria in the soft tissues which make gas, clostridium difficile is the classic bug WWI and shit. Sub-q emphysema with skin infection is, perhaps worse than sub-q emphysema from trauma. toodles.

I am guessing that the sub-q emphasema is not air, but rather, combustion gasses injected into the soft tissues from the (rather close) muzzle at discharge (of the gun, not the patient). However, as noted earlier, this is a matter of academic curiosity with no clinical relevance. There is no foot or ankle left to save.

Man, if the AAHA (american animal hospital association) saw one of my tech's hands like that on one of the radiographs in our hospital, we would lose our accreditation faster than a cat can make me sneeze!